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Gout in Childhood and Adolescence

Gout is a form of joint swelling (arthritis), which typically occurs in the big toe, foot, ankle, or knee. A gout attack usually begins with quite severe pain in one of these joints. The pain can be so severe that the person cannot even have a bed sheet touching the joint. The joint is often hot and swollen. Over several days to a week, the pain from the gout often improves and goes away, but gout will often occur again. 

Gout is caused by elevated blood uric acid levels. Uric acid can build up due to increased intake or production of uric acid or due to the decreased removal of uric acid by the kidneys. Sometimes excessive intake of substances containing uric acid can lead to gout. 

Many people think of gout being caused by excess intake of beer, alcohol, meat, and shellfish. While these may cause a gout attack to occur, there are usually other reasons that individuals have gout. These factors are usually NOT the causes of gout in children and teenagers. 

If a child or teenager has gout, it is important that blood and urine tests be done to determine why gout has occurred. It is usually a sign of an underlying problem that is often easily treated.  

In children, the first test to do if gout is suspected is to measure the blood uric acid level.  If this is elevated (>6), this could be a sign that gout is present.  Other important procedures are for a doctor to insert a needle into the affected joint, withdraw fluid, and examine this fluid for uric acid crystals. 

Causes of gout in children and teenagers include: 

1. Inherited conditions that cause over-production of uric acid. These include HPRT deficiency (also known as Lesch Nyhan syndrome) and PRPP synthetase overactivity. These disorders are uncommon but are easily tested for. Patients produce extra uric acid and can have gout and kidney stones containing uric acid. These conditions usually occur in boys but can occasionally happen in girls as well.  

2. Kidney diseases resulting in decreased ability of the body to get rid of uric acid.

There are several types: 
a. The most common type is due to mutations in the gene that produces a protein called uromodulin. In this condition, patients develop gout in their teenage years and have slow worsening of kidney failure over time. There are usually many other family members who have had gout or kidney disease. 

b. Another cause of this condition is a mutation in the gene that makes the protein renin. In this condition, children have a history of relatively low blood pressure, anemia (low blood count), and mild kidney disease. The blood potassium levels are often mildly elevated. The anemia is present from the time the child is young, and often the cause of the anemia is not known. This condition is easily diagnosed and treatable with medications. Patients with this condition often have a father or mother who has gout, anemia as a child, and kidney disease. 

c. Any type of kidney disease can also cause gout in childhood.

3. Patients who are overweight and have high blood pressure can also be at risk for gout. This usually occurs in the 20’s and 30’s, but it is becoming more common in young individuals. This is called Metabolic Syndrome.

If you have a child that you believe may have gout or has been diagnosed with gout, please contact Dr. Bleyer.  He can help advise on further testing.

    Dr. Anthony BleyerDr. Anthony Bleyer at Wake Forest School of Medicine conducts research into the causes of gout in childhood.  

    If you have any questions, please contact Dr. Bleyer at 336-716-4513 or email at

    Last Updated: 08-22-2016
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